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Article: Impact of infectious diseases consultation on the outcome of patients with bacteraemia.

Jiménez-Aguilar, Patricia / López-Cortés, Luis Eduardo / Rodríguez-Baño, Jesús

Therapeutic advances in infectious disease

2019 Volume 6, Page(s) 2049936119893576

Abstract: Bacteraemia or bloodstream infections (BSI) are associated with much morbidity and mortality. Management of patients with bacteraemia is complex, and the increase in immunosuppressed patients and multidrug-resistant organisms poses additional challenges. ...

Abstract	Bacteraemia or bloodstream infections (BSI) are associated with much morbidity and mortality. Management of patients with bacteraemia is complex, and the increase in immunosuppressed patients and multidrug-resistant organisms poses additional challenges. The objective of this review is to assess the available published information about the impact of different aspects of management on the outcome of patients with BSI, and, specifically, the importance of infectious diseases specialists (IDS) consultation. The impact of management by IDS on different aspects, including interpretation of newer rapid techniques, early evaluation and treatment, and follow up, are reviewed. Overall, the available data suggest that IDS intervention improves the management and outcome of patients with BSI, either through consultation or structured unsolicited interventions in the context of multidisciplinary bacteraemia programmes.
Language	English
Publishing date	2019-12-06
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2728410-4
ISSN	2049-937X ; 2049-9361
ISSN (online)	2049-937X
ISSN	2049-9361
DOI	10.1177/2049936119893576
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Article ; Online: Traqueobronquitis obstructiva por Aspergillus fumigatus en un paciente inmunocompetente.

Romero-Palacios, Alberto / Mera Gallardo, Oliva / Jiménez Aguilar, Patricia / Borrallo Torrejón, José Javier / Maza Ortega, Carmen / Rodriguez-Iglesias, Manuel A

Revista iberoamericana de micologia

2018 Volume 36, Issue 1, Page(s) 34–36

Abstract: Background: Aspergillus tracheobronchitis (ATB) is an uncommon type of invasive pulmonary aspergillosis in which fungal involvement is limited to the tracheobronchial tree. While the more severe forms, such as pseudomembranous and ulcerative ATB, occur ... ...

Title translation	Obstructive tracheobronchitis due to Aspergillus fumigatus in an immunocompetent patient.
Abstract	Background: Aspergillus tracheobronchitis (ATB) is an uncommon type of invasive pulmonary aspergillosis in which fungal involvement is limited to the tracheobronchial tree. While the more severe forms, such as pseudomembranous and ulcerative ATB, occur almost exclusively in immunocompromised patients, the milder obstructive form may occur in patients without immune deficiency. Case report: The case of a 32 year-old man with no previous history of illness, who was evaluated for recurrent right lower lobe pneumonia, is presented. Microbiological sputum studies revealed growth of Serratia marcescens, and a limited growth of Aspergillus fumigatus, the latter interpreted as a contaminant in the specimen. Bronchoscopy revealed a dense mucous plug at level B10 of the right lower lobe, which could not be removed; no other macroscopic findings of interest were observed. During his hospital admission, the patient expectorated the mucous plug and had a significant subsequent bronchorrhoea. A substantial number of colonies of A. fumigatus grown in the sputum cultures. The patient was given voriconazole, leading to a clinical resolution, with no recurrences. Conclusions: Obstructive ATB is characterised by the excessive production of thick, hyphae-laden mucus, which can obstruct the airway lumen and generate relapsing post-obstructive pneumonias. It is important to consider this diagnosis in immunocompetent patients with recurrent respiratory infections and who show repeated isolation of Aspergillus colonies in the sputum, even in small quantities.
MeSH term(s)	Adult ; Airway Obstruction/etiology ; Airway Obstruction/microbiology ; Aspergillosis/complications ; Aspergillus fumigatus ; Bronchitis/complications ; Bronchitis/microbiology ; Humans ; Immunocompetence ; Male ; Tracheitis/complications ; Tracheitis/microbiology
Language	Spanish
Publishing date	2018-11-30
Publishing country	Spain
Document type	Case Reports ; Journal Article
ISSN	2173-9188
ISSN (online)	2173-9188
DOI	10.1016/j.riam.2018.03.003
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Article ; Online: Efficacy and safety of a structured de-escalation from antipseudomonal β-lactams in bloodstream infections due to Enterobacterales (SIMPLIFY): an open-label, multicentre, randomised trial.

López-Cortés, Luis Eduardo / Delgado-Valverde, Mercedes / Moreno-Mellado, Elisa / Goikoetxea Aguirre, Josune / Guio Carrión, Laura / Blanco Vidal, María José / López Soria, Leyre Mónica / Pérez-Rodríguez, María Teresa / Martínez Lamas, Lucía / Arnaiz de Las Revillas, Francisco / Armiñanzas, Carlos / Ruiz de Alegría-Puig, Carlos / Jiménez Aguilar, Patricia / Del Carmen Martínez-Rubio, María / Sáez-Bejar, Carmen / de Las Cuevas, Carmen / Martín-Aspas, Andrés / Galán, Fátima / Yuste, José Ramón /

Leiva-León, José / Bou, Germán / Capón González, Patricia / Boix-Palop, Lucía / Xercavins-Valls, Mariona / Goenaga-Sánchez, Miguel Ángel / Anza, Diego Vicente / Castón, Juan José / Rufián, Manuel Recio / Merino, Esperanza / Rodríguez, Juan Carlos / Loeches, Belén / Cuervo, Guillermo / Guerra Laso, José Manuel / Plata, Antonio / Pérez Cortés, Salvador / López Mato, Pablo / Sierra Monzón, José Luis / Rosso-Fernández, Clara / Bravo-Ferrer, José María / Retamar-Gentil, Pilar / Rodríguez-Baño, Jesús

The Lancet. Infectious diseases

2024 Volume 24, Issue 4, Page(s) 375–385

Abstract: Background: De-escalation from broad-spectrum to narrow-spectrum antibiotics is considered an important measure to reduce the selective pressure of antibiotics, but a scarcity of adequate evidence is a barrier to its implementation. We aimed to ... ...

Abstract	Background: De-escalation from broad-spectrum to narrow-spectrum antibiotics is considered an important measure to reduce the selective pressure of antibiotics, but a scarcity of adequate evidence is a barrier to its implementation. We aimed to determine whether de-escalation from an antipseudomonal β-lactam to a narrower-spectrum drug was non-inferior to continuing the antipseudomonal drug in patients with Enterobacterales bacteraemia. Methods: An open-label, pragmatic, randomised trial was performed in 21 Spanish hospitals. Patients with bacteraemia caused by Enterobacterales susceptible to one of the de-escalation options and treated empirically with an antipseudomonal β-lactam were eligible. Patients were randomly assigned (1:1; stratified by urinary source) to de-escalate to ampicillin, trimethoprim-sulfamethoxazole (urinary tract infections only), cefuroxime, cefotaxime or ceftriaxone, amoxicillin-clavulanic acid, ciprofloxacin, or ertapenem in that order according to susceptibility (de-escalation group), or to continue with the empiric antipseudomonal β-lactam (control group). Oral switching was allowed in both groups. The primary outcome was clinical cure 3-5 days after end of treatment in the modified intention-to-treat (mITT) population, formed of patients who received at least one dose of study drug. Safety was assessed in all participants. Non-inferiority was declared when the lower bound of the 95% CI of the absolute difference in cure rate was above the -10% non-inferiority margin. This trial is registered with EudraCT (2015-004219-19) and ClinicalTrials.gov (NCT02795949) and is complete. Findings: 2030 patients were screened between Oct 5, 2016, and Jan 23, 2020, of whom 171 were randomly assigned to the de-escalation group and 173 to the control group. 164 (50%) patients in the de-escalation group and 167 (50%) in the control group were included in the mITT population. 148 (90%) patients in the de-escalation group and 148 (89%) in the control group had clinical cure (risk difference 1·6 percentage points, 95% CI -5·0 to 8·2). The number of adverse events reported was 219 in the de-escalation group and 175 in the control group, of these, 53 (24%) in the de-escalation group and 56 (32%) in the control group were considered severe. Seven (5%) of 164 patients in the de-escalation group and nine (6%) of 167 patients in the control group died during the 60-day follow-up. There were no treatment-related deaths. Interpretation: De-escalation from an antipseudomonal β-lactam in Enterobacterales bacteraemia following a predefined rule was non-inferior to continuing the empiric antipseudomonal drug. These results support de-escalation in this setting. Funding: Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases; Spanish Clinical Research and Clinical Trials Platform, co-financed by the EU; European Development Regional Fund "A way to achieve Europe", Operative Program Intelligence Growth 2014-2020.
MeSH term(s)	Humans ; beta-Lactams/adverse effects ; Anti-Bacterial Agents/adverse effects ; Ceftriaxone ; Ertapenem ; Bacteremia/drug therapy ; Treatment Outcome
Chemical Substances	beta-Lactams ; Anti-Bacterial Agents ; Ceftriaxone (75J73V1629) ; Ertapenem (G32F6EID2H)
Language	English
Publishing date	2024-01-09
Publishing country	United States
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article
ZDB-ID	2061641-7
ISSN	1474-4457 ; 1473-3099
ISSN (online)	1474-4457
ISSN	1473-3099
DOI	10.1016/S1473-3099(23)00686-2
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Article ; Online: Unsolicited consultation by infectious diseases specialist improves outcomes in patients with bloodstream infection: A prospective cohort study.

Jiménez-Aguilar, Patricia / Romero-Palacios, Alberto / De-la-Calle, Iría-Jesus / Martínez-Rubio, María-Carmen / Girón-González, José-Antonio / Rodríguez-Baño, Jesus

The Journal of infection

2018 Volume 77, Issue 6, Page(s) 503–508

Abstract: Introduction: The objective of this study was to evaluate the impact of an intervention based on unsolicited consultations by an infectious diseases specialist (IDS) on the adequacy of antimicrobial treatment and mortality in patients with BSI.: ... ...

Abstract	Introduction: The objective of this study was to evaluate the impact of an intervention based on unsolicited consultations by an infectious diseases specialist (IDS) on the adequacy of antimicrobial treatment and mortality in patients with BSI. Methods: A prospective cohort study was performed in a 410-bed hospital. An intervention based on unsolicited consultation by an IDS for patients with BSI was performed only on days when an IDS was available. Outcomes were the percentage of days on optimal antimicrobial treatment (PDOAT) and mortality. Analyses were performed by linear regression and multivariate logistic regression. Results: Of 400 episodes of BSI included, 292 received the intervention. The median (interquartile range) PDOAT among those with and without the intervention was 93 (6-100) and 0 (0-53), respectively. The intervention was independently associated with a higher PDOAT (r = 0.5; p < 0.001) but not with mortality. The IDS recommendations were followed in full in 183 episodes, and not in 109. Mortality was 10.4% and 27.6%, respectively. Adherence to recommendations was associated with lower mortality (adjusted OR = 0.3; 95% CI: 0.1-0.5). Conclusions: An intervention based on unsolicited IDS consultation for BSI episodes was associated with improved use of antibiotics and, when the recommendations were fully followed, with lower mortality.
MeSH term(s)	Aged ; Bacteremia/drug therapy ; Bacteremia/mortality ; Communicable Diseases/drug therapy ; Early Medical Intervention/methods ; Female ; Humans ; Male ; Medicine ; Middle Aged ; Physicians ; Prospective Studies ; Referral and Consultation ; Spain
Language	English
Publishing date	2018-08-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	424417-5
ISSN	1532-2742 ; 0163-4453
ISSN (online)	1532-2742
ISSN	0163-4453
DOI	10.1016/j.jinf.2018.08.014
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Article ; Online: Quasiexperimental intervention study protocol to optimise the use of new antibiotics in Spain: the NEW_SAFE project.

Palacios-Baena, Zaira R / Valiente de Santis, Lucia / Maldonado, Natalia / Rosso-Fernández, Clara M / Borreguero, Irene / Herrero-Rodríguez, Carmen / López-Cárdenas, Salvador / Martínez-Marcos, Franciso J / Martín-Aspas, Andrés / Jiménez-Aguilar, Patricia / Castón, Juan J / Anguita-Santos, Francisco / Ojeda-Burgos, Guillermo / Aznarte-Padial, M Pilar / Praena-Segovia, Julia / Corzo-Delgado, Juan E / Esteban-Moreno, M Ángeles / Rodríguez-Baño, Jesús / Retamar, Pilar

BMJ open

2020 Volume 10, Issue 7, Page(s) e035460

Abstract: Introduction: Ceftaroline, tedizolid, dalbavancin, ceftazidime-avibactam and ceftolozane-tazobactam are novel antibiotics used to treat infections caused by multidrug-resistant pathogens (MDR). Their use should be supervised and monitored as part of an ... ...

Abstract	Introduction: Ceftaroline, tedizolid, dalbavancin, ceftazidime-avibactam and ceftolozane-tazobactam are novel antibiotics used to treat infections caused by multidrug-resistant pathogens (MDR). Their use should be supervised and monitored as part of an antimicrobial stewardship programme (ASP). Appropriate use of the new antibiotics will be improved by including consensual indications for their use in local antibiotic guidelines, together with educational interventions providing advice to prescribers to ensure that the recommendations are clearly understood. Methods and analysis: This study will be implemented in two phases. First, a preliminary historical cohort (2017-2019) of patients from 13 Andalusian hospitals treated with novel antibiotics will be analysed. Second, a quasiexperimental intervention study will be developed with an interrupted time-series analysis (2020-2021). The intervention will consist of an educational interview between prescribers and ASP leaders at each hospital to reinforce the proper use of novel antibiotics. The educational intervention will be based on a consensus guideline designed and disseminated by leaders after the retrospective cohort data have been analysed. The outcomes will be acceptance of the intervention and appropriateness of prescription. Incidence of infection and colonisation with MDR organisms as well as incidence of Ethics and dissemination: Ethical approval will be obtained from the Andalusian Coordinating Institutional Review Board. The study is being conducted in compliance with the protocol and regulatory requirements consistent with International Council of Harmonisation E6 Good Clinical Practice and the ethical principles of the latest version of the Declaration of Helsinki. The results will be published in peer-reviewed journals and disseminated at national and international conferences. Trial registration number: NCT03941951; Pre-results.
MeSH term(s)	Antimicrobial Stewardship/methods ; Antimicrobial Stewardship/standards ; Azabicyclo Compounds/therapeutic use ; Ceftazidime/therapeutic use ; Cephalosporins/therapeutic use ; Clinical Protocols ; Drug Combinations ; Humans ; Interrupted Time Series Analysis ; Medication Systems/standards ; Oxazolidinones/therapeutic use ; Practice Patterns, Physicians'/standards ; Spain ; Tazobactam/therapeutic use ; Teicoplanin/analogs & derivatives ; Teicoplanin/therapeutic use ; Tetrazoles/therapeutic use ; Ceftaroline
Chemical Substances	Azabicyclo Compounds ; Cephalosporins ; Drug Combinations ; Oxazolidinones ; Tetrazoles ; avibactam, ceftazidime drug combination ; ceftolozane, tazobactam drug combination ; Teicoplanin (61036-62-2) ; dalbavancin (808UI9MS5K) ; tedizolid (97HLQ82NGL) ; Ceftazidime (9M416Z9QNR) ; Tazobactam (SE10G96M8W)
Language	English
Publishing date	2020-07-31
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2019-035460
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Article ; Online: Hepatic Safety of Rilpivirine/Emtricitabine/Tenofovir Disoproxil Fumarate Fixed-Dose Single-Tablet Regimen in HIV-Infected Patients with Active Hepatitis C Virus Infection: The hEPAtic Study.

Neukam, Karin / Espinosa, Nuria / Collado, Antonio / Delgado-Fernández, Marcial / Jiménez-Aguilar, Patricia / Rivero-Juárez, Antonio / Hontañón-Antoñana, Victor / Gómez-Berrocal, Ana / Ruiz-Morales, Josefa / Merino, Dolores / Carrero, Ana / Téllez, Francisco / Ríos, María José / Hernández-Quero, José / de Lagarde-Sebastián, María / Pérez-Camacho, Inés / Vera-Méndez, Francisco / Macías, Juan / Pineda, Juan A

PloS one

2016 Volume 11, Issue 5, Page(s) e0155842

Abstract: Objectives: The aim of this study was to evaluate the frequency of transaminase elevations (TE) and total bilirubin elevations (TBE) during the first year of therapy with a single tablet regimen including RPV/FTC/TDF (EPA) in HIV/hepatitis C virus (HCV)- ...

Abstract	Objectives: The aim of this study was to evaluate the frequency of transaminase elevations (TE) and total bilirubin elevations (TBE) during the first year of therapy with a single tablet regimen including RPV/FTC/TDF (EPA) in HIV/hepatitis C virus (HCV)-coinfected subjects in clinical practice. Methods: In a retrospective analysis, HIV/HCV-coinfected subjects who started EPA at 17 centres throughout Spain were included as cases. Subjects who started an antiretroviral therapy (ART) other than EPA during the study period at the same hospitals were randomly selected as controls in a 1:2 ratio. Primary outcome variables were grade (G) 3-4 TE and G4 TBE. Results: Of the 519 subjects included, 173 individuals started EPA. Nine (5.2%) subjects of the EPA group and 49 (14.2%) controls were naïve to ART. The median (Q1-Q3) follow-up was 11.2 (9.7-13.9) months. TE was observed in 2 [1.2%; 95% confidence interval (CI): 0.14%-4.1%] subjects receiving EPA and 11 (3.2%; 95%CI: 1.6%-5.6%) controls (p = 0.136), all events were G3. No patient discontinued ART due to TE. One (0.6%; 95%CI: 0.01%-3.1%) subject on EPA and 8 (2.3%; 95%CI: 1%-4.5%) subjects in the control group developed TBE (p = 0.141), without developing any other hepatic event during follow-up. Three (2.3%) subjects with cirrhosis versus 10 (3.1%) without cirrhosis showed G3-4 TE (p = 0.451). Conclusion: The frequency of severe liver toxicity in HIV/HCV-coinfected subjects receiving EPA under real-life conditions is very low, TE were generally mild and did not lead to drug discontinuation. All these data suggest that EPA can be safely used in this particular subpopulation.
MeSH term(s)	Adult ; Anti-Retroviral Agents/administration & dosage ; Antiviral Agents/administration & dosage ; Bilirubin/metabolism ; Case-Control Studies ; Coinfection/drug therapy ; Coinfection/virology ; Drug Therapy, Combination ; Emtricitabine/administration & dosage ; Female ; Fibrosis/drug therapy ; HIV Infections/complications ; HIV Infections/drug therapy ; Hepacivirus ; Hepatitis C/complications ; Hepatitis C/drug therapy ; Hospitalization ; Humans ; Liver/drug effects ; Liver/enzymology ; Male ; Middle Aged ; Retrospective Studies ; Rilpivirine/administration & dosage ; Spain ; Tablets ; Tenofovir/administration & dosage ; Transaminases/metabolism
Chemical Substances	Anti-Retroviral Agents ; Antiviral Agents ; Tablets ; Tenofovir (99YXE507IL) ; Transaminases (EC 2.6.1.-) ; Rilpivirine (FI96A8X663) ; Emtricitabine (G70B4ETF4S) ; Bilirubin (RFM9X3LJ49)
Language	English
Publishing date	2016-05-19
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0155842
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Article ; Online: (with research data) Effectiveness of Ritonavir-Boosted Protease Inhibitor Monotherapy in Clinical Practice Even with Previous Virological Failures to Protease Inhibitor-Based Regimens.

López-Cortés, Luis F / Castaño, Manuel A / López-Ruz, Miguel A / Rios-Villegas, María J / Hernández-Quero, José / Merino, Dolores / Jiménez-Aguilar, Patricia / Marquez-Solero, Manuel / Terrón-Pernía, Alberto / Tellez-Pérez, Francisco / Viciana, Pompeyo / Orihuela-Cañadas, Francisco / Palacios-Baena, Zaira / Vinuesa-Garcia, David / Fajardo-Pico, Jose M / Romero-Palacios, Alberto / Ojeda-Burgos, Guillermo / Pasquau-Liaño, Juan

PloS one

2016 Volume 11, Issue 2, Page(s) e0148924

Abstract: Background and objective: Significant controversy still exists about ritonavir-boosted protease inhibitor monotherapy (mtPI/rtv) as a simplification strategy that is used up to now to treat patients that have not experienced previous virological failure ...

Abstract	Background and objective: Significant controversy still exists about ritonavir-boosted protease inhibitor monotherapy (mtPI/rtv) as a simplification strategy that is used up to now to treat patients that have not experienced previous virological failure (VF) while on protease inhibitor (PI) -based regimens. We have evaluated the effectiveness of two mtPI/rtv regimens in an actual clinical practice setting, including patients that had experienced previous VF with PI-based regimens. Methods: This retrospective study analyzed 1060 HIV-infected patients with undetectable viremia that were switched to lopinavir/ritonavir or darunavir/ritonavir monotherapy. In cases in which the patient had previously experienced VF while on a PI-based regimen, the lack of major HIV protease resistance mutations to lopinavir or darunavir, respectively, was mandatory. The primary endpoint of this study was the percentage of participants with virological suppression after 96 weeks according to intention-to-treat analysis (non-complete/missing = failure). Results: A total of 1060 patients were analyzed, including 205 with previous VF while on PI-based regimens, 90 of whom were on complex therapies due to extensive resistance. The rates of treatment effectiveness (intention-to-treat analysis) and virological efficacy (on-treatment analysis) at week 96 were 79.3% (CI95, 76.8-81.8) and 91.5% (CI95, 89.6-93.4), respectively. No relationships were found between VF and earlier VF while on PI-based regimens, the presence of major or minor protease resistance mutations, the previous time on viral suppression, CD4+ T-cell nadir, and HCV-coinfection. Genotypic resistance tests were available in 49 out of the 74 patients with VFs and only four patients presented new major protease resistance mutations. Conclusion: Switching to mtPI/rtv achieves sustained virological control in most patients, even in those with previous VF on PI-based regimens as long as no major resistance mutations are present for the administered drug.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; DNA Mutational Analysis ; Drug Resistance, Viral ; Female ; HIV Infections/drug therapy ; HIV Infections/mortality ; HIV Infections/virology ; HIV Protease/genetics ; HIV Protease Inhibitors/pharmacology ; HIV Protease Inhibitors/therapeutic use ; HIV-1/enzymology ; HIV-1/genetics ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Mutation ; Retrospective Studies ; Ritonavir/pharmacology ; Ritonavir/therapeutic use ; Treatment Outcome ; Young Adult
Chemical Substances	HIV Protease Inhibitors ; HIV Protease (EC 3.4.23.-) ; Ritonavir (O3J8G9O825)
Language	English
Publishing date	2016-02-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0148924
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Article ; Online: Risk of liver decompensation among HIV/hepatitis C virus-coinfected individuals with advanced fibrosis: implications for the timing of therapy.

Macías, Juan / Márquez, Manuel / Téllez, Francisco / Merino, Dolores / Jiménez-Aguilar, Patricia / López-Cortés, Luis F / Ortega, Enrique / von Wichmann, Miguel A / Rivero, Antonio / Mancebo, María / Santos, Jesús / Pérez-Pérez, Montserrat / Suárez-Lozano, Ignacio / Romero-Palacios, Alberto / Torres-Cornejo, Almudena / Pineda, Juan A

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2013 Volume 57, Issue 10, Page(s) 1401–1408

Abstract: Background: Most human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-infected patients who are currently receiving boceprevir or telaprevir-based therapy against HCV show cirrhosis. However, the risk of liver decompensation (DC) among HIV/HCV- ... ...

Abstract	Background: Most human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-infected patients who are currently receiving boceprevir or telaprevir-based therapy against HCV show cirrhosis. However, the risk of liver decompensation (DC) among HIV/HCV-coinfected patients with stage 3 fibrosis in the short term could be high enough to not allow delays. We aimed at assessing the risk of DC among HIV/HCV-coinfected individuals with advanced fibrosis (F3-F4). Methods: Eight hundred ninety-two HIV/HCV-coinfected patients, naive or without sustained virologic response to HCV therapy, were included in this cohort. Fibrosis was staged by biopsy in 317 patients and by liver stiffness measurement (LSM) in 575 individuals. Precirrhosis was defined as an LSM of 9.5-14.6 kilopascals (kPa), and cirrhosis as an LSM of ≥14.6 kPa. Results: For patients with biopsy, the probability of remaining free of DC for F3 vs F4 was 99% (95% confidence interval [CI], 95%-100%) vs 96% (95% CI, 91%-98%) at 1 year, and 98% (95% CI, 94%-100%) vs 87% (95% CI, 81%-92%) at 3 years. The only factor independently associated with DC was fibrosis stage (F4 vs F3, subhazard ratio [SHR], 2.1; 95% CI, 1.07-4.1; P = .032). For patients with LSM, the probability of remaining free of DC for precirrhosis vs cirrhosis was 99% (95% CI, 96%-100%) vs 93% (95% CI, 89%-96%) at 1 year, and 97% (95% CI, 94%-99%) vs 83% (95% CI, 77%-87%) at 3 years. Factors independently associated with DC were platelet count (<100 × 10(3) vs ≥100 × 10(3): SHR, 1.86; 95% CI, 1.01-3.42; P = .046) and LSM (cirrhosis vs precirrhosis: SHR, 5.67; 95% CI, 2.27-14.1; P < .0001). Conclusions: As in patients with cirrhosis, immediate therapy against HCV is warranted for patients with precirrhosis and HIV coinfection, as they are at risk of DC soon after the diagnosis of advanced fibrosis.
MeSH term(s)	Adult ; Analysis of Variance ; Biopsy ; Female ; HIV Infections/virology ; Hepatitis C/pathology ; Hepatitis C/virology ; Humans ; Liver Cirrhosis/pathology ; Liver Cirrhosis/virology ; Liver Failure/pathology ; Liver Failure/virology ; Male ; Middle Aged ; Retrospective Studies
Language	English
Publishing date	2013-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/cit537
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Article ; Online: Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state

Rodríguez-Baño, Jesús / Pachón, Jerónimo / Carratalà, Jordi / Ryan, Pablo / Jarrín, Inmaculada / Yllescas, María / Arribas, José Ramón / Berenguer, Juan / Aznar Muñoz, Esther / Gil Divasson, Pedro / González Muñiz, Patricia / Muñoz Aguirre, Clara / Díaz Menéndez, Marta / de la Calle Prieto, Fernando / Arsuaga Vicente, Marta / Trigo Esteban, Elena / Pérez Valero, Ignacio / de Miguel Buckley, Rosa / Cadiñaños Loidi, Julen /

Diaz Pollan, Beatriz / Martín Carbonero, Luz / Ramos Ramos, Juan Carlos / Loeches Yagüe, Belén / Montejano Sánchez, Rocío / González García, Juan / García Rodríguez, Julio / Ramírez, Margarita / Gutiérrez, Isabel / Tejerina, Francisco / Aldámiz-Echevarría, Teresa / Díez, Cristina / Fanciulli, Chiara / Pérez-Latorre, Leire / Pinilla, Blanca / López, Juan Carlos / Such Diaz, Ana / Álvaro Alonso, Elena / Torres Macho, Juan / Cuevas Tascon, Guillermo / Jiménez González de Buitrago, Eva / Brañas Baztán, Fátima / Valencia de la Rosa, Jorge / Pérez Butragueño, Mario / Fernández Jiménez, Inés / Muñiz Nicolás, Gemma / Sepúlveda Berrocal, Antonia / Gato Díez, Alberto / Toledano Sierra, María Pilar / García Butenegro, María Paz / Peláez Ballesta, Ana Isabel / Morcillo Rodríguez, Elena / Fernández Romero, Isidoro / Peláez Ballesta, Cristina / Guirado Torrecillas, María Isabel / Goikoetxea Agirre, Josune / Bereciartua Bastarrica, Elena / Guio Carrión, Laura / Rodríguez Álvarez, Regino / Ibarrola Hierro, Marta / Pérez Hernández, Isabel A. / Pérez Zapata, Inés / Román Soto, Sergio / Kallouchi, Mohamed / Domínguez Vicent, Juan Ramón / Silvariño Fernández, Rafae / Ugalde Espiñeira, Jon / Sanjuan López, Ainhoa / García Martínez, Silvia / Temprano Gogenola, Mikel / Asensi, Víctor / Suárez, Silvia / Suárez, Lucia / Yllera, Carmen / Rivas-Carmenado, María / Romero-Palacios, Alberto / Ruiz Aragón, Jesús / Jiménez Aguilar, Patricia / Fernández Ávila, Ma Luisa / Castilla Ortiz, Rosario / Alende Castro, Vanesa / Pérez García, Cristina / Fernández Morales, Marta / Valle Feijoo Begoña Rodríguez Ferreira, María Lorena María / Gómez-Junyent, Joan / Villar-García, Judit / López-Montesinos, Inmaculada / Arrieta-Aldea, Itziar / Rial-Villavecchia, Abora / García Vázquez, Elisa / Roura Piloto, Aychel Elena / Moral Escudero, Encarnación / Hernández Torres, Alicia / Albendín Iglesias, Helena / Vinuesa García, David / Martínez Montes, Clara / De la Hera Fernández, Francisco Javier / Anguita Santos, Francisco / Ruiz Sancho, Andrés / Díaz de Brito Fernández, Vicens / Sanmarti Vilamala, Montserrat / España Cueto, Sergio / Molina Morant, Daniel / González-Cuevas, Araceli / Chara Cervantes, Joel Elías / Policarpo Torres, Guillem / Ortega Montoliu, Meritxell / Angerri Nadal, Mònica / De Genover Gil, Ariadna / Patera, Eleni / Godoy Lorenzo, Rita / Zioga, Evangelia Anna María / Isern Fernández, Virginia / Sabbagh Fajardo, Carlos Enrique / Ferrer Ribera, Ana / Bea Serrano, Carlos / Oltra Sempere, Rosa / Vela Bernal, Sara / Albiol Viñals, Paloma / Pedromingo Kus, Miguel / Garcinuño, María Ángeles / Fiorante, Silvana / Pérez Pinto, Sergio / de la Vega, Alexandra / Fariñas Álvarez, María Carmen / González Rico, Claudia / Arnaiz de las Revillas, Francisco / Giménez, Teresa / Calvo, Jorge / Meije Castillo, Yolanda / Duarte Borges, Alejandra / Pareja Coca, Júlia / Clemente Presas, Mercedes / Sanz Salvador, Xavier / Pérez Rodríguez, Ma Teresa / Sousa, Adrián / Pérez González, Alexandre / Longueira, Rebeca / Araujo, Alejandro / Alonso Martínez, Blanca / García Escudero, Laura / Lidia Kamel Rey, Sara / Roa Alonso, David / Avilés Parra, Juan Pablo / Pelegrín Senent, Iván / Rouco Esteves Marques, Rosana / Raich Montiu, Laia / Souto Higueras, Jessica / Gálvez Bobadilla, Manuel Alejandro / Parra Ruiz, Jorge / Ramos Sesma, Violeta / Velasco Fuentes, Sara / García Pereña, Laura / Lluna Carrascosa, Alfonso / Gilaberte Reyzábal, Sergio / Liébana Gómez, Mónica / Salillas Hernando, Juan / Serrano Martínez, Alberto / Torralba González de Suso, Miguel / Martínez Martín, Patricia / Rábago Lorite, Isabel / González-Ruano Pérez, Patricia / Pérez-Monte Mínguez, Beatriz / García Flores, Ángeles / Comas Casanova, Pere / Martín Plata, Andrea / Santana Báez, Sergio Manuel / Sanz Peláez, Oscar / Mohamed Ramírez, Karim / Robaina Bordón, José María / Vílchez Rueda, Helem Haydeé / Riera Jaume, Melchor / Mut Ramon, Gemma / Gavalda Manso, Meritxell / Planas Bibiloni, Lluis / Castelo Corral, Laura / Ramos Merino, Lucía / Sánchez Vidal, Efrén / Rodríguez Mayo, María / Míguez Rey, Enrique / García de Lomas Guerrero, José M. / De la Torre Lima, Javier / Correa Ruiz, Ana / Fernández Sánchez, Fernando / Jiménez-García, Nicolás / Sierra-Monzón, José Luis / Gracia-Tello, Borja / Hernández-Bonaga, María / Pellejero, Galadriel / Asín-Corrochano, Marta / Boix Palop, Lucia / Calbo, Esther / Badía, Cristina / Dietl, Beatriz / Lucía, Gómez / Domínguez-Castellano, Ángel / Ríos-Villegas, María José / del Toro, María D. / Palacios Baena, Zaira R. / Salamanca-Rivera, Elena / Marín, Elena / Almadana, Virginia / Pérez-Galera, Salvador / González-Iglesias, Luisa / Abelenda-Alonso, Gabriela / Álvarez-Pouso, Claudia / Escrihuela, Francesc / Gudiol, Carlota / Lorenzo-Esteller, Laia / Niubó, Jordi / Podzamczer, Daniel / Pujol, Miquel / Rombauts, Alexander / Salvert Lletí, Miguel / Gil Sánchez, Ricardo / Jiménez Escrig, Marta / Parra Gómez, Laura / Tasias Pitarch, Mariona / Navarro Vilasaró, Marta / Machado Sicilia, María Luisa / Gomila Grange, Aina / Calzado Isbert, Sonia / Carrasco Antón, Nerea / Petkova-Saiz, Elizabet / Cabello Úbeda, Alfonso / Górgolas Hernández-Mora, Miguel / Sánchez-Pernaute, Olga / Dueñas Gutiérrez, Carlos / Martin Guerra, Javier / Castrodeza Sanz, José Javier / Fernández Espinilla, Virginia / Rodríguez Fernández, Laura / González-Moreno, Juan / Villoslada Gelabert, Aroa / Ribot Sanso, María Antonia / Fernández-Baca, María Victoria / Hernández Milian, Almudena / Morán Rodríguez, Miguel Ángel / Ortiz de Zárate Ibarra, Zuriñe / Portu Zapirain, José Joaquin / Saez de Adana Arroniz, Ester / Gainzarain Arana, Juan Carlos / Meca Birlanga, Olga / del Amor Espín, Ma Jesús / Viqueira González, Montserrat / García García, Josefina / Martínez Madrid, Onofre / Bernal Morell, Enrique / Alcaraz, Antonia / Muñoz, Ángeles / Pina, Ignacio / de la Rosa, Vicente / Caínzos Romero, Tamara / Sánchez Trigo, Sabela / Mariño Callejo, Ana Isabel / Álvarez Díaz, Hortensia / Valcarce Pardeiro, Nieves / Sánchez Serrano, Adriana / Piñar Cabezos, Diana / García Villalba, Eva Pilar / Aguayo Jiménez, Carmen / Ruíz Campuzano, María / Naranjo Velasco, Virginia / Santos Peña, Marta / Mora Delgado, Juan / Sevilla Moreno, Israel / Lojo Cruz, Cristina / Kortajarena Urkola, Xabier / Iribarren Loyarte, José Antonio / Bustinduy Odriozola, María Jesús / Ibarguren Pinilla, Maialen / Álvarez Rodríguez, Ignacio / Martínez Marcos, Francisco Javier / Rodríguez Gómez, Francisco Javier / Asschert Agüero, Isabel / Muñoz Beamud, Francisco / Ruiz Reina, Antonio José / Llenas-García, Jara / González-Cuello, Inmaculada / Hellín-Valiente, Elena / Martínez Birlanga, Esther / Tafalla Torres, José Manuel / Calderón Parra, Jorge / Escudero López, Gabriela / Gutiérrez Martín, Isabel / Andrés Eisenhofer, Ane / García Prieto, Sonia / Álvarez Franco, Raquel / Roger Zapata, Daniel / Martínez Cifre, Blanca / Aranda Rife, Elena / Martín Rubio, Irene / Barbosa Ventura, André / Garrido, Javier / Gonzalo, Concepción / Piñero, Iván / de la Cruz Felipe, Nieves / Talavera García, Eva / Lamata Subero, Marta / Mendoza Roy, Paula / García de Carlos, María Soledad / Lajusticia Aisa, Justo / Arteche Eguizabal, Lorea / Urrutia Losada, Ainhoa / Domingo Echaburu, Saioa / Cuadros Tito, Pedro Ángel / Orbe Narváez, Gurutz / Liébana Martos, Ma del Carmen / Roldán Fontana, Carolina / Herrero Rodríguez, Carmen / Duro Ruiz, Gaspar / Pérez Parra, Santiago / Mera Fidalgo, Arantzazu / Hortos Alsina, Miquel / Alberich Conesa, Ana / Bladé Vidal, Lourdes / Merchante Gutiérrez, Nicolás / León Jiménez, Eva / Espíndola Gómez, Reinaldo / Erostarbe Gallardo, María / Martínez Pérez-Crespo, Pedro / Cisneros, José Miguel / Aguilar-Guisado, Manuela / Aldabó, Teresa / Bueno, Claudio / Cordero-Matía, Elisa / Escoresca, Ana / Infante, Carmen / Guillermo, Martín / Salto, Sonsoles / Gioia, Francesca / Vizcarra, Pilar / Fortún Abete, Jesús / Martín Dávila, Pilar / Moreno Guillén, Santiago / Oteo Revuelta, José A. / García-García, Concepción / Santibañez Sáenz, Paula / Cervera Acedo, Cristina / Azcona Gutiérrez, José M. / Reguera Iglesias, José María / Plata Ciezar, Antonio / Valiente de Santis, Lucia / Sobrino Diaz, Beatriz / Ruiz Mesa, Juan Diego

Clinical Microbiology and Infection ; ISSN 1198-743X

a multicentre cohort study (SAM-COVID-19)

2020

Keywords	Microbiology (medical) ; Infectious Diseases ; General Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
DOI	10.1016/j.cmi.2020.08.010
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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